Indian-Americans and other South Asians are more likely to die of heart disease, including heart attacks and strokes caused by atherosclerosis than East Asians and non-Hispanic whites living in the United States, the American Heart Association has warned.
In a new scientific statement that provides an overview of behaviors that influence risk factors for heart disease and stroke among South Asians in the U.S., the association said statistics about heart disease and stroke risk among Asians “can be deceiving” when all people of Asian ethnicity are combined into one group.
“Overall, Asians are at a lower risk for heart disease and stroke compared to people of European ancestry, but when you look at South Asians – both immigrants and people of South Asian ancestry born in the United States – their risk for heart disease and stroke is higher than people from East Asia and people of European ancestry,” said Annabelle S. Volgman, chair of the statement’s writing group and professor of medicine at Rush Medical College and medical director of the Rush Heart Center for Women in Chicago, in a May 24 press release.
The release said more than 3.4 million people, who identify themselves as South Asians, live in the United States, and about 80 percent come from India while others come from Bangladesh, Bhutan, the Maldives, Nepal, Pakistan and Sri Lanka. This group includes both immigrants and people of South Asian ancestry born in the U.S., according to the United States Census.
Compared to people of European ancestry, South Asian-American as a group have a greater risk of severe atherosclerosis – the narrowing of the arteries that underlies most heart disease and strokes. They are also more likely to have higher levels of artery-clogging LDL cholesterol and triglycerides, which predispose the arteries to develop fatty deposits in artery walls that cause them to narrow. They are also more likely to have lower levels of HDL, the beneficial cholesterol.
“They also have a higher level of calcium deposits, a marker for atherosclerosis, if they are of Indian ancestry and over age 60 and are more likely to have diabetes which is believed to accelerate atherosclerosis and develop diabetes at a younger age,” said the statement.
The statement also focuses on behavioral factors that may increase the risk of developing atherosclerosis among South Asian Americans and suggests ways that they can be changed to improve health.
Volgman notes that diet is a key factor. Many South Asians, even if they are vegetarians, eat a lot of saturated fats from tropical oils such as palm and coconut oil and refined carbohydrates such as sugar, white bread and highly processed foods.
Ongoing studies are looking into improving diet quality among South Asians by reintroducing traditional whole grains which were once a mainstay of diet in the region, in addition to suggesting replacing ghee - butter with all the water removed - with monounsaturated oils, such as olive, corn or other oils.
South Asian-Americans also engage in less physical activity than other minority group members, according to the statement. “As healthcare providers, we need to do a better job of helping our South Asian patients understand the importance of exercise, because many don’t realize how important it is to their health,” said Volgman.
A recent study found that only 49 percent of South Asian-Americans believed that exercise was important in preventing heart disease.
The co-authors of the statement include Latha S. Palaniappan, the vice chair, and Neelum T. Aggarwal, Milan Gupta, Abha Khandelwal, and Aruna V. Krishnan.
The authors cite studies that suggest that community programs that encourage South Asians to exercise and reduce stress through yoga and Bollywood dancing or other culturally-specific physical activities are likely to be more successful than other forms of physical activity.
The statement concludes with a call to action to include more South Asians, one of the fastest growing ethnic groups in the U.S, in research studies to better understand how to reduce their risk for heart disease and stroke.